Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.


Diffusion Tensor and Perfusion Magnetic Resonance Imaging Delineates Microstructural Changes of Inflammation and Differentiates Between Tuberculosis and Chronic Inflammatory Arthritis.

Agarwal1,  Vikas, Awasthi2,  Rishi, Tripathi3,  Deepak, Agrawal3,  Vinita, Singh Rathore4,  Ram Kishore, Sahoo4,  Prativa, Sharma5,  Kusum

Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Lucknow, India
Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India,, Lucknow, India
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Lucknow, India
Indian Institute of Technology, Kanpur, India
Postgraduate Institute of Medical Education and Research, Chandigarh, India

Background/Purpose:

Conventional MRI does not differentiate between infective and non-infective chronic inflammatory arthritis. Synovial histology and culture are the only means to differentiate between these two. Chronic inflammation is characterized by cellular infiltration and increased vascularity. We hypothesize that Diffusion tensor imaging (DTI), a non-contrast MRI technique, delineates synovial inflammation. DTI derived metrics [fractional anisotropy (FA), mean diffusivity (MD), linear anisotropy (CL), planar anisotropy (CP) and cylindrical isotropy (CS)] and perfusion parameters [blood flow (BF) and blood volume (BV)] assess cellular infiltration and vascularity, respectively, in inflamed synovium. Also, increased inflammation during infection should lead to greater variation in DTI and perfusion parameters that should differentiate between the two conditions.

Methods:

Patients with knee arthritis (>3 months duration) underwent conventional and DTI (3T scanner) followed by arthroscopic biopsy. Synovial tissue was subjected to histopathology, immunohistochemistry (IHC), and culture and multiplex PCR for Mycobacterium tuberculosis. In-house developed software was used to process DTI and perfusion data. Pearson correlation coefficient was used to evaluate correlation between DTI and perfusion and IHC parameters. Independent samples t-test was used to compare parameters between tubercular and non-tubercular patients. Discriminant analysis was done to ascertain imaging parameters discriminant of tuberculosis.

Results:

There were 41 patients (mean age 38 years, [range 18–75], 27 male). Ten patients had tuberculosis and rest had; chronic monoarthritis (n=11), undifferentiated spondyloarthropathy (n=12), osteoarthritis (n=3), reactive (n=2) and rheumatoid, juvenile idiopathic and lepra reaction one each. There was significant correlation between the DTI, perfusion and IHC parameters (Table-1). DTI, perfusion and IHC parameters were significantly different in the tubercular as compared to the non-tubercular group (Table-2). FA and blood volume were 100% sensitive and specific in discriminating and predicting tuberculosis.

Table 1. Correlation coefficient (R) between DTI, Perfusion and IHC markers (n=41)

ParameterCD3CD4CD8CD68Total cellsCD34CD54TNFaIL-1b
FA0.59*0.64*0.46@0.63*0.77*0.84*0.45@0.69*0.67*
MD-0.41@-0.39#-0.28-0.32#-0.46@-0.49@-0.27-0.3-0.48#
CL0.44@0.53*0.32#0.36#0.49@0.62*0.180.38#0.54*
CP0.36#0.240.33#0.210.260.170.050.33#0.13
CS-0.3-0.44@-0.18-0.28-0.42@-0.51@-0.56*-0.41@-0.42@
Blood flow0.39@0.42@0.230.49@0.58*0.73*0.4@0.58*0.55*
Blood volume0.59*0.66*0.53*0.53*0.75*0.90*0.50@0.64*0.77*
*p<0.001,@p<0.01,#p<0.05

Table 2. Comparison of DTI, perfusion and IHC markers between tubercular and non-tubercular groups

ParametersTuberculosis (n=10) Mean ± SDNon-tubercular (n=31) Mean ± SDP value
DTI   
FA0.27 ± 0.010.21 ± 0.00<0.001
MD1.01 ± 0.04  1.6 ± 0.540.002
CL0.08 ± 0.020.05 ± 0.02<0.001
CP0.16 ± 0.040.14 ± 0.050.27
CS0.69 ± 0.050.76 ± 0.03<0.001
Perfusion   
BV16.24 ± 1.993.23 ± 2.22<0.001
BF161.26 ± 16.999.22 ± 36.55<0.001
IHC   
CD3193.40 ± 61.99112.87 ± 39.56<0.001
CD497.80 ± 33.8048.03 ± 18.40<0.001
CD872.80 ± 17.5142.90 ± 25.290.001
CD68253.90 ± 64.10157.94 ± 70.72<0.001
CD34194.60 ± 51.7341.42 ± 18.35<0.001
CD5490.30 ± 62.3433.71 ± 13.63<0.001
TNFa33.10 ± 7.9018.77 ± 7.94<0.001
IL-1b55.90 ± 14.5021.30 ± 11.93<0.001

Conclusion:

DTI and perfusion scan clearly differentiates between the tubercular and non-tubercular arthritis.

To cite this abstract, please use the following information:
Agarwal, Vikas, Awasthi, Rishi, Tripathi, Deepak, Agrawal, Vinita, Singh Rathore, Ram Kishore, Sahoo, Prativa, et al; Diffusion Tensor and Perfusion Magnetic Resonance Imaging Delineates Microstructural Changes of Inflammation and Differentiates Between Tuberculosis and Chronic Inflammatory Arthritis. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :954
DOI:

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